WASHINGTON, DC – Today, a new issue brief analyzes the health reform effort in Massachusetts, and how it built on existing coverage systems such as Medicaid and the Children’s Health Insurance Program (CHIP), to reach an unprecedented 98.8% rate of insurance for children.

The paper provides a detailed look at how Massachusetts covers children and their parents, as well as the aspects of the Massachusetts model that have contributed to its success. It was commissioned by First Focus and authored by Beth Waldman, a former Massachusetts Medicaid and CHIP director during the development and implementation of that state’s health care reform effort.

While the brief supports the research finding that children are more likely to have health coverage if their parents are insured, it also underscores that it is not essential for each family member to have an identical insurance package because children have different health care needs than adults.

In fact, Massachusetts achieved family coverage by building on existing coverage systems, including CHIP, and streamlining enrollment processes. The most important component is that every family member has coverage, not that the coverage is provided by the same insurer.

“There are many parallels between the health reform efforts in both Massachusetts and the federal debate that is currently underway,” said Bruce Lesley, President of First Focus, a bipartisan children’s advocacy organization. “Massachusetts was successful in leveraging existing programs, such as Medicaid and CHIP to provide nearly universal coverage for children. And while Congress continues to debate the repeal of CHIP in favor of unity of coverage for families, it is important to note that Massachusetts has been enormously successful maintaining CHIP and covering children and parents in separate programs. Because the state built on existing infrastructure, streamlined enrollment, and coordinated communication across all programs, the Massachusetts model has been remarkably effective in moving the state toward universal coverage for children.”

The paper describes the coverage systems upon which health reform was built and the new mechanisms implemented after the state’s landmark health reform legislation was enacted in 2006.

Among the key findings of the brief are:

  • Massachusetts successfully serves children and parents in two separate programs, CHIP and Commonwealth Care (CommCare).
  • The state leveraged its existing infrastructure to quickly and easily expand coverage for children within the existing Medicaid/CHIP (MassHealth) program. Specifically, the state provided coverage to families with incomes at or below 300% of the federal poverty level (FPL) by expanding CHIP to cover children to 300% of the FPL. It also established a new program, CommCare, for adults with incomes up to 300% of the FPL, administered by the Commonwealth Health Insurance Connector Authority (Connector).
  • In order to avoid confusion related to maintaining separate premium structures for each program, Massachusetts waives premiums for children covered through CHIP when parents are subject to cost-sharing in CommCare.
  • Massachusetts utilized a joint application process for MassHealth and CommCare, allowing families to complete one application even though coverage might ultimately be provided through a number of different health coverage options.

Health reform legislation recently passed by the House of Representatives repeals CHIP entirely, rolling millions of children and pregnant women from CHIP into the untested “health insurance exchange.” In addition, measures to fully fund CHIP through 2019 are being debated in the U.S. Senate.